* **Patient:** Female * **DOB:** 2nd April 1951 * **POB:** Richmond, Virginia (DOB + POB = late spring/summer (K,P) * **TOB:** 3:30 pm (V) * **Height:** 5' 5" * **Weight:** 120 lbs (V), says that she is gaining weight mostly in fat (K) * **Bone Structure:** [[Pitta]] primarily. * **As a 10 year old:** was very skinny but gained weight and became very chubby after the removal of her tonsils, went on a diet when she was 9 (K) * **Sleep:** Could fall asleep right away(K) but dreams a lot (sleeps during V or P times). Drools a lot during sleep (K) * **Emotions:** Anxiety primarily (V) * [[Cholesterol]]: There is a very slight diagonal crease in the earlobe which is indicative of the beginning of Kapha in the heart and the body in a subtle way (K). * **Bowel Movement:** variable, varies from 1 to 4, but mostly constipated (hard stool) and a feeling that stool is not fully eliminated, diarrhea follows constipation ([[Vishama Agni]]) * **Ama (tongue exam):** not bad, has yellow coating [[ama]], which indicates that she had recently eaten [[Pitta]] provoking food or has yellow ama. Patient says that she has white coating at the back of her tongue when she wakes up in the morning (K). * **Nails:** missing all the moons which indicates [[Manda Agni]]. * **Pulse:** rapid speed, indicates [[Vata]] and [[Pitta]], shows disturbed [[Kapha]]. Indicates V2P3K1 [[prakruti]]. * **Menstruation:** 16 years old (K), irregular (V), during menstruation it stops and starts again (V),yeast infection ([[Leucorrhea]]) when was younger (K) * **Main Health Concern:** [[Thyroid]] problem and [[menopause]]. She has [[Hyothyroidism]] ([[Manda Agni]]). She has an [[Autoimmune]] disorder where her body is attacking her thyroid thinking that it is an enemy. She has been taking Chinese herbs for a week, she does not take any other kind of medication for her thyroid problem. * **Others:** Has hot flashes (related to menopause). Has cold hands and feet despite hot flashes (V).\\ \\
* The patient asked if the doctor would take her pulse. He said that this shall be done later on when the patient settles and not right away. Also, according to Ayurveda, there are other steps in clinical assessment that come before pulse taking. These are: **Darshan** (look), **Sparshan** (listen), **Prashna** (question and discuss) and pulse taking comes at last. * Sleep, food and sex are the 3 pillars of good health. Any of these in excess or deficiency will always cause disease, and in proper amounts will cause health. * **Sleep:** The patient sleeps late at night. It is best to sleep during [[Kapha]] time (between 6 – 10 pm) and wake up during Kapha time (6 – 10 am). The patient is advised to go to bed between 9:00 pm and 10:30 pm and sleep at 11:00 pm the latest. These times have some [[Kapha]] energy waning out that helps you go to sleep. Waking up at [[Kapha]] time helps you dispel excess Kapha. Sleeping during wring hours can cause weight gain. * **Diet:** since the patient has [[hypothyroidism]] which leads to gain weight she must avoid salty, sweet, oily and cold foods. Salty and sweet foods are [[anabolic]] in nature and cause weight gain. Suitable foods in general are those that are dry and astringent, such as dry granola, dry oats, bitter vegetables (patient said that she gets shaky when she eats those food because she is Vata, the doctor said these are just general recommendation because of the time limit of the consultation). Spicy is also good, but since she has hot flashes she should avoid spicy food. * She gets hot flashes because she is menopausal. [[Pitta]] shares the oily quality with [[Kapha]], and oily foods aggravate Pitta and Kapha, thus oily deep fried foods, as well as creamy and foods (which mainly fatty and oily), will increase heat in the body and increase the [[manda agni]]. * Doctor said that he will treat the Kapha because it is out of balance. You do not treat the constitution; you treat that which is out of balance. Always treat the disturbed dosha, which is Kapha in this case (because of her [[hypothyroidism]], white [[ama]] on tongue, feeling fatigued, sleeping during Kapha hours, and gaining weight). * [[Vata]] can push [[Kapha]]. We live in a Vata disturbing society, which make us crave for Vata soothing diet wthe phich naturally aggravates Kapha. * Ayurveda teaches us never to treat the disease's name, always treat the dosha instead. Ayurveda looks at the qualities and the gunas. * The patient asked about [[progesterone]] cream, and the doctor said that he could not answer because he was not western trained, yet [[Evening Primrose]] could be used to treat her menopause problems including the hot flashes.\\ \\
* 5 pts [[Chitrak]] ([[Plumbago zeylanica]]), V-P+K-, best herb for K/V digestion, best herb to kindle [[agni]] regardless of agni disturbance. * 4 pts [[Guduchi]] ([[Tinospora cordifolia]]), V-P-K-, the patient is too Vata disturbed to give her [[Kutki]], Guduchi is good for her agni, reduces her (P) hot flashes. * 2 pts [[Gokshura]] ([[Tribulus terrestris]]), V-P-K=, for her bladder problem and kidneys. * 2 pts [[Shatavari]] ([[Asparagus racemosus]]), V-P-K=, best herb for Pitta women, good for the hot flashes. * 3 pts [[Brahmi]] ([[Centella asiatica]]), (was going to prescribe [[Jatamamsi]] ([[Nardostachys jatamamsi]]) but the patient said that she was allergic to it), for P related insomnia and anxiety. * 3 pts [[Chandraprabha]] or Moon Glow, soothes V and aggravates P in large amounts, herbal compound, good whenever there is manda agni or vishama agni.\\ \\
//Take 1/2 tsp (if sensitive to herbs) to 1 tsp (if not sensitive) 3 times a day before food to kindle agni with 1 tsp of raw uncooked honey (lekhana and best vehicle or anupan for herbs) with a cup (4oz – 8oz cup) of water. May be taken in anyway comfortable, either a spoon of herbs mixed with honey and then drinking water as a chaser, or seeping herbs in hot water for 5 minutes and adding honey to that, or any other way.
Patient said that she thought that honey was Pitta provoking. Doctor answered that her Pitta is not as aggravated as her Kapha, plus honey here is used as an anupan and to do lekhana.//
Take 1 tsp of Triphala powder if constipated. 1/2 tsp if not constipated. 1 tsp once at night and once in the morning if very constipated.
If taking tablets or capsules, take 4 tablets/capsules if constipated, and if not 1-2 tablets.
Triphala is to be taken an hour before bedtime on an empty stomach.